Pre-debridement wound cultures not found to be helpful in guiding management.

Tetanus Immunization

If no booster in last 5 years

Add human tetanus immune globulin for immunocompromised patients, patients that have not had a booster in the last 10 years, and for any wounds suspected to be colonized with tetani,

Provide analgesia

Consult orthopedics for possible surgical management

Do not irrigate, debride or probe wound in the ED if immediate operative intervention is planned. This may further contaminate the tissue or force debris deeper into the wound. If there is a delay to operative management, irrigate with saline and cover with a sterile dressing

Prognosis:

Infection of open fracture may lead to delayed union, non-union, multiple additional surgeries and amputation